Studio randomizzato sull'efficacia del concentrato piastrinico nell'inserimento immediato di impianti dentali in siti post-estrattivi infetti
Progetto Background. Dental implants are a consolidated treatment for replacing missing teeth, allowing restoration of chewing function, speech, and aesthetics. Traditionally, before placing dental implants, compromised teeth are removed and the extraction sockets are left to heal for between several months and 1 year. However, alveolar ridge resorption after tooth extraction may considerably reduce the residual bone volume and compromise the favourable positioning of implants required for optimal restoration. Immediate postextraction implant placement is a well accepted protocol due to the preservation of aesthetics, shorter total treatment time, maintenance of socket walls, reduced surgical time. However, compromised teeth that are indicated for extraction are frequently involved with infectious conditions, which conventionally contraindicate their immediate replacement with endosseous dental implants. Recent evidence showed that success can be achieved if certain preoperative and postoperative measures are followed, such as antibiotic administration, meticulous cleaning, and alveolar debridement, before surgical procedure. The mismatch between the implant surface and the socket walls may sometimes represent a problem. The latter has been tackled in different ways: specific implant design (troncoconical shape, large diameter), weeks of healing before implant placement, the use of regenerative techniques (bone grafts, GBR, growth factors). Platelet Rich Fibrin Matrix (PRFM) is an autologous product enriched in growth factors, that has been recently proposed as an aid for enhancing regeneration of osseous and epithelial tissues in oral surgery. Several in vitro studies, animal experiments and clinical trials showed that platelet-derived growth factors may effectively trigger stimulation of osseous and soft tissue regeneration, as well as reduce inflammation, pain and unwanted side effects.
Methods. This will be a prospective randomized clinical trial. Patients with tooth elements with chronic periapical or periodontal infections clinically and radiographically diagnosed, candidate to tooth extraction, will be randomized either to a group treated by conventional immediate post-extraction implant insertion procedure alone or to a group treated with the adjunct of PRFM. The latter is obtained by centrifugation of 10cc blood drawn intraoperatively from the patient, in closed circuit. All patients will be clinically and radiographically evaluated yearly up to 5 years.
Aim. The purpose of the present randomized trial is to evaluate the healing of the hard and soft tissues around implants immediately placed into infected fresh extraction sockets, using or not an autologous product rich in growth factors during the surgical procedure.